Normal tension Glaucoma

[NaeemAyub]

Briefly, i had segmented scleral buckle surgery in Feb 2016 in left eye, after that i took Glaucoma medicine to control IOP for about 4 months; later it was stopped by doctor gradually as IOP was between 12-15mmHG;

however in last visit to dr on 16th oct he noticed cup to disk ratio high in both eyes ( i didn't ask if the change is recent between now and last visit or ..)  anyhow he recommended OCT of optic nerve and vision field test; he wanted to see if i might have normal tension glaucoma...

above  said tests were carried out, the reports can be reached by following drop box link.

https://www.dropbox.com/s/mzdnvffc9aqyrf0/OCT%20and%20Vision%20field%20test%20reports%20done%20on%2017%20oct%202016.pdf?dl=0


the dr has recommended to start glaucoma medicine again to lower the pressure even more and repeat the test in 6 months time to see the variation.  I am looking for a second opinion before starting Glaucoma medication.

Any advise would be highly appreciated.

[JohnHaganMD]

I just finished listening to a lecture on normal tension glaucoma and I do think treatment is indicated and that the consultant will agree with treating.   Use google and search normal tension glaucoma    Be sure you do not take blood pressure medication at bedtime.  Don't use any nicotine or cannabis products. The OCT test is the most disturbing.  

[NaeemAyub]

Thank you for your kind response, I dont smoke or anything after seeing somewhere i restricted coffee intake as well.
Could you please explain a little more about OCT report for both eye separately?

lastly, Is the problem in initial stage or advance? can the damaged done be reversed? and if i start taking glaucoma medication at IOP of 12 to 15mmHG, is there any dangerously lower limits of IOP as well?

[NaeemAyub]

Dear John,
In addition to above,  i am mntioning below to reach to the route cause,

-In my family nobody has any optic nerve related issue,

- i use to have migraine with aura almost 1 to 2 time a month, last one i had about 15 years ago, the migraine was cured with only 2 months medication from a neurologist.

- i have blood coagulation factor XI deficiency.  

- my blood pressure  usually remains around 120-140/80-100.

looking forward for your kind reply.

[JohnHaganMD]

=

[NaeemAyub]

Dear john...awaiting your kind response.
Br//naeem

[JohnHaganMD]

In OCT green is good, yellow is borderline and red is danger. So your cup to disc ratio is large and your optic nerve rim tissue is very thin.   You would need one of two courses.  Have those tests ever been done before or is the the first time. Most ophthalmologists would either start treatment for low pressure glaucoma or insist on following you every 4-6 months and seeing if those tests worsen, if so you would need RX wither latanprost at bedtime or maybe alphagan-P.  Caffeine is not a problem. As I said don't use nicotine or cannabis

[NaeemAyub]

Dear Dr.
Thanks for your detailed response.   OCT of optic nerve and visual field has been done for the first time... i have consulted another dr today, who said that one must have at least 3 visual field tests at certain interval at same setup (same machine/software etc.) to be sure, whether its a Glaucoma case or not..
additionally according to him i have tilted disc in left eye; due to which some results/parameters of OCT came in Red area, otherwise both eyes have same cup to disk ratio, can tilted eye be a factor? with him today the IPO was left 21, right 20 ( through air puff Tonometer APT)  , the other doctor used to check by goldmann tonometer and the average results used to be 12-15 in both eyes...

Lastly i am confused to  conclude; whether i should wait for 5-6 months to repeat these test in same setup at least once and then based on the results comparison; proceed to treatment,  please advise ....

apology for bothering you,

Thanks a lot for your time and efforts, Have a nice days.

Br//NAEEM,

[JohnHaganMD]

Your situation is not usual. In terms of what eye MDs do every day trying to decide in an early stage whether someone has glaucoma or needs treatment (you can not have glaucoma and still warrant treatment if the risks of developing glaucoma are high. )  Does either of these two eye MDs specialize in glaucoma? If so that person has extra training in glaucoma and more experience.  If neither are do you have access to a glaucoma specialist Eye MD? If you do taking all your tests in might be the best solution.  If you do not have access to glaucoma MD then you should probably follow up with the MD you felt the most confidence in. In a situation like yours at your age, with no family history of glaucoma and all these tests being done for the first time it would probably be acceptable to most Eye MDs to check you every 6 months alternating the visual field and nerve fiber layer OCT looking for worsening.  In borderline cases most Eye MDs do not like to make a diagnosis based on the first VF and first OCT and first look at a optic nerve.

[NaeemAyub]

well,  I am in search of a glaucoma Specialist, hoping to find one very soon. If his advise will be convincing then i'll follow, else otherwise; so far with your valuable advice and the other 2 MDs,  It seems that waiting for another VF test and OCT by march 2017 to be sure of the diagnosis is better and  logical; because if i start medication right away, i will remain uncertain about the existence of condition/disease forever.  In this case I intend to keep an eye on IOP every 6 to 8 weeks and follow other precautions you mentioned earlier  about avoiding nicotine, canaabis etc.

Thanks and have a nice days.

[JohnHaganMD]

You too and best of luck

[JohnHaganMD]

=